The NHS is a socialised health system. It relies on individuals and institutions earning money to pay taxes into a central pot, from which a proportion is used as the health budget. There can be no denying that it operates on socialist principles. It is feted as something that makes the UK great, resonating with the statement of Mahatma Ghandi that ‘a nation’s greatness is measured by how it treats its weakest members’.
We now have a government that is committed to principles of capitalism, ideologically opposed to socialist values, and as a party has previously privatised the railways, energy companies, telecommunications, the mail system and the prisons in part. Allowing market economics to prevail seems akin to making the pervading principle: ‘Every man/woman/child for themselves’.
This is made even clearer by the pre-election pledge to cut the welfare bill of the country by £12 billion. We all need to be taking home more money so we have to rely less on one another.
The question on the lips of colleagues working in the NHS, especially in England, in the last few days has been: ‘What will happen to the NHS in the next five years?’
My crystal ball unfortunately holds few answers. Maybe uncertainty will undermine any attempts to resolve the various crises – if that is not too strong a word – affecting general practice in particular; issues of recruitment, retention, workload and morale being perhaps the most pertinent.
I would hazard a guess, crystal ball discarded, at the following:
– Any attempt to repeal or amend the Health and Social Care Act in parliament will fail as the whips of a majority government will ensure it remains.
– The pressure on health services will increase as continued austerity measures and promised cuts in welfare push older and frailer patients to seek help from the point of care of least resistance.
– The portrayal of general practice in the media, fed by the government, will continue to be negative as the current government will need someone to blame the ‘failure’ of the NHS on, thereby legitimising its privatisation.
The next five years could determine whether socialised health care can be compatible with the ethos of consumerism, encouraged in our patients, that is derived from the application of market economic principles.
Good luck, everyone. I think we’re going to need it.
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.
